Would it be ethical to allow an AI to make life-or-death medical decisions?
I will interpret the questions as being about triage. This is particularly important in crisis situations, where a lot of such life-or-death decisions have to be taken.

In the START system there are four different categories:


the deceased, who are beyond help
the injured who could be helped by immediate transportation
the injured with less severe injuries whose transport can be delayed
those with minor injuries not requiring urgent care.


According to the category assigned to a patient, you then decide what to do. Other systems might be more fine-grained, but the principle is the same: effectively the human decision is in the classification, which then guides the assignment of resources. In the above list, the second category would probably be the highest priority for treatment. But once the category has been decided, the course of action has been determined, though the actual treatment options will then be considered for each case.

The ethics are thus in the judgment of the survival chances: if a nurse decides patient X is too far gone to warrant treatment, that's it. So this is the hard part, the life-or-death decision.

There are then two aspects to consider:


The accuracy of the diagnosis
The predicted likelihood of treatment being effective


The diagnosis should be (I'm not a medic!) fairly neutral. There are of course mis-diagnoses, but there is no value judgment involved. There might be some 'leakage' between step 1 and step 2, in that a human being might be influenced by the prospects of treatment of a diagnosis when deciding what the problem is. As in: this is a nice person, I don't want them to die, so I (subconsciously) exclude the diagnosis X which would mean certain death.

In this case a computer system that had sufficient accuracy when making a diagnosis would IMHO actually be more ethical than a human being. Provided, of course, that there is no bias in the diagnosis. Which I think is a practical problem, but in theory could be dealt with.

Once the diagnosis has been determined, the estimation of treatment success is the next decision. This also can be subject to human error, and a computer system with access to statistical information (again, unbiased) of issues and their likelihood of survival could be more independent of other factors which a human being might use, but which are unrelated to the case.

So basically, I would say that a computer system could be more ethical than a human being in such a situation. Because you can defend the way it reached it's decision, and it has been without taking into account factors not related to the problem at hand.

However, it's not always that easy. There are plenty of cases where other factors influence the decision. As long as there are fixed rules, that might not be a problem, though. Some issues would be (in each case the patients would have the same diagnosis and projected survival chance):


One ventilator, but an 8-year-old child and a 85-year-old man
A 30-year-old pregnant woman and the Prime Minister of the country
A one-month-old baby and a 25-year-old student
A homeless person and a billionaire


As a given, the system would have to be agnostic of general features such as gender, race, religion, etc. But how do you take into account age, social status, and a whole host of other factors?

If there is no difference in the situation, the fairest way would be to toss a coin. That would surely upset a lot of people ("How can you justify leaving our president to die in this time of crisis!"), but if you had explicit rules ("If one patient is in a higher tax bracket, they get priority") you might upset even more people. The advantage of having such rules would be to make the bias explicit, and in a way protect a nurse or paramedic from having to decide between a rich senator and a homeless person &mdash; whose family is more likely to go after you if you decided against them? And if you have explicit, unambiguous rules, why not use them to guide an AI system?

Every human being has their own preferences, and I am glad that I don't have to make those kinds of decisions &mdash; it sounds like a horrific task to me. How can you even sleep in peace after basically having condemned one each of the above cases to death?

That is another factor about the ethics of AI: by relieving humans from having to make such decisions, it would also have a beneficial effect. If the final decision is the same that the human would come to, then it's a win/win situation. But that is probably unlikely, due to a whole range of subconscious biases.

The prime issue to me seems the lack of recourse in the case of "computer said no". When a human makes a decision (like a referee in a game), there will always be an argument if people are unhappy with it. But in this case there could be none. The oracle has spoken, your father will be left to die. Sorry, no other outcome possible. It would probably be the same with a human decision, but it wouldn't feel as 'cold': you can observe that the person making the decision has to struggle with it. And you might understand that it was not an easy choice. With a computer, that element is missing.

Anyway, to summarise: given various caveats,


sufficiently accurate and unbiased diagnosis,
unbiased prediction of treatment outcome,
transparent handling of non-medical factors,


I would say that an AI system would me more ethical, as it has a principled way of reaching a decision which does not disadvantage any group of patients and would always get the same decision for the same patient; furthermore it takes a heavy burden off triage staff who otherwise have to make such decisions.

Which does not mean that I would be happy with my loved-ones' survival being decided by such a system :)